Abstract Background and aims Acute intracerebral hemorrhage frequently presents with moderate to severe neurological deficits, requiring rapid clinical stratification. The NIHSS is widely used for assessing stroke severity, while biochemical markers such as MMP-9 may reflect underlying pathophysiological processes contributing to disease progression. Methods Fifty patients with acute intracerebral hemorrhage were included in the study. Neurological status was assessed in the acute phase using the NIHSS. Based on NIHSS scores, patients were categorized into mild, moderate, severe, and very severe clinical groups. Plasma MMP-9 levels were measured, and their relationship with clinical severity was analyzed using appropriate statistical methods. Results The majority of patients presented with moderate to very severe neurological deficits. Severe and very severe cases together accounted for more than half of the cohort, highlighting the critical nature of acute ICH. The average NIHSS score was 16, indicating significant neurological impairment. Plasma MMP-9 levels were elevated across all severity groups and demonstrated a progressive increase with rising NIHSS scores. A strong positive correlation was observed between MMP-9 concentration and clinical severity (p 0.001), suggesting that higher NIHSS scores are associated with greater biological activity of secondary brain injury mechanisms. Conclusions Acute intracerebral hemorrhage is predominantly characterized by moderate to severe neurological impairment at presentation. Increasing plasma MMP-9 levels parallel the escalation of clinical severity assessed by the NIHSS. These findings support the complementary use of biochemical markers alongside clinical scales to better characterize disease burden and potentially refine early clinical stratification in patients with intracerebral hemorrhage. Conflict of interest Nothing to disclose
Musayev et al. (2026) studied this question.